4 things you need to know about hyperemesis gravidarum

It's estimated that around 10,000 women a year suffer from hyperemesis gravidarum (HG), a condition that at its most extreme can leave sufferers with a torn oesophagus, burst blood vessels, eroded tooth enamel and post traumatic stress disorder (PTSD). Yet all too often is airily dismissed as bad morning sickness - a term which in itself is misleading, as any women who has experienced the grind of all-day pregnancy nausea will tell you.

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"HG can result in vomiting up to 50 times a day and, in extreme cases, hospitalisation to combat dehydration and so that nutritional support can be given intravenously," says Caitlin Dean, a registered general nurse and vice chair for the charity Pregnancy Sickness Support.

"To diagnose such women with 'just' bad morning sickness only adds to their suffering. Luckily, we're much more enlightened about the condition now, but even so, around 1000 women a year choose to have an abortion because they can no longer cope with the vomiting and constant nausea. Some women can't swallow because the saliva in their mouth makes them throw up, and others find the smell of their husband or children makes them feel sick, which is very distressing. Often the nausea can be worse than the sickness itself."

For women expecting their first child, many assume what they're experiencing is normal – after all, up to 90% of mums-to-be experience some form of sickness during the first trimester, and "many women actually find feeling sick a comfort, as it's a sign the pregnancy hormones are kicking in," says Caitlin. "Hyperemesis is a different proposition altogether, but it's amazing some women put up with before realising their symptoms are not normal and seeking help."

Maddie Caruthers, 32, had HG with her first child, Ben, now five, and her second, Edie, eight months:

"With Ben, it started at four weeks and eased off at about 20,' she says. 'I can only describe it as a living hell. One of the worst aspects was feeling as though I just wasn't coping – I'd never heard of HG and just assumed I needed to toughen up. When my symptoms carried on after the 12-week mark, I was devastated. I'd been so sure I'd start feeling better after that milestone and when I didn't, I was hysterical. Thankfully my GP came to see me at home and diagnosed HG – physically I felt as bad as ever, but at least now I knew it wasn't all in my head and I had somewhere to go for support. It made all the difference."

As to what causes hyperemesis, it's thought there is a genetic element (you're 30% more likely to suffer with it if your mum or sister did) but "it's multifactorial and often we're not sure why some women get it and others don't," says Caitlin. And sadly, if you've had it once, it's likely to recur with subsequent pregnancies, a fact that saw Maddie delay extending her family by a couple of years longer than she would have liked. "It took me a long time to feel mentally ready to be pregnant again," she says. "It wasn't so bad the second time around, although I remember holding Ben's hand when we were out on the street one day and having to kneel down on the pavement while I was sick down a drain."

Remember, too, that you're also entitled to take time off work if you have hyperemesis. "It's unlawful discrimination for an employer to treat a woman unfavourably because of her pregnancy or an illness relating to her pregnancy," says Caitlin. "There's also small crumb of comfort to be had from the fact that from around week 18 a lot of women start to feel significantly better, and after the baby is born the sickness stops completely."

What else you need to know

1. Will HG put my baby at risk?

A study by Dr Rebecca Painter of the Academic Medical Centre in Amsterdam, which looked at the babies of mothers who were pregnant during the Dutch famine of 1944-45 and severely undernourished during early pregnancy as a result, found that they were more susceptible to heart disease, stress-related conditions and obesity in later life. "Unfortunately, it seems there might be some lifelong complications associated with severe malnourishment during the early weeks, which is why it's important to seek help sooner rather than later," says Caitlin Dean. "It's just as important we rule out any other underlying cause for extreme sickness, which can sometimes occur as a result of an undiagnosed urinary tract infection (UTI), for instance,' says Dr Clare Bailey, a GP and founder of parenting support organisation Parenting Matters. "In a way, hyperemesis is a diagnosis of exclusion, but once confirmed, we can start to treat. If you lose more than 5% of your pre-pregnancy weight, you might need nutritional intervention so inform your GP. "

2. Will anti-sickness drugs harm my baby?

"There is absolutely no evidence that the standard anti-emetic (sickness) drugs used to treat HG are harmful," says Dr Bailey. "They're most effective if started as soon as possible and can be used in combination to find the most effective way of reducing sickness in each individual."

3. Is there any food or drink I might be able to tolerate?

Dry, bland, foods such as crackers or plain white toast might help, if eaten very slowly – perhaps just a quarter of a slice of toast every 15 minutes, advises Caitlin. Sucking an ice cube may be better tolerated than sips of water. You might want to avoid ginger, however, despite the fact it's oft mentioned as a traditional cure for sickness. "You need to consider how it will feel to vomit ginger back up,' says Caitlin. 'It's painful. And one of the studies we've done on combatting pregnancy sickness showed it not to be effective anyway."

4. How to get support

Both Caitlin Dean and Dr Bailey emphasise the need to ask for help – from your partner, GP, family and friends. The Pregnancy Sickness Support helpline (024 7638 2020) offers a national support network of trained volunteers who are peer-matched so that they can offer more appropriate advice, says Caitlin. "If you're talking to someone who knows only too well what it's like trying to hold down a job as a teacher with HG, for instance, that connection with your personal circumstances really helps. We offer text and email support too, if women are too ill to hold a conversation over the phone."

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